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Redefining Policy Making Taking Action to Influence Policy Policy for Rural Women
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The Mice That Roared: Using Feminist Principles in Research to Influence Policy Nancy Poole, BC Centre of Excellence for Women’s Health
In late 1970s the zany American feminist, Flo Kennedy, offered some advice to feminist activists on strategy. She said that it would always be more problematic for those in power to face 10,000 mice unleashed in a room than a single roaring lion. This image of the unfettered mice may serve to inspire those who are seeking ways to guide research and animate research findings to change the shape of women’s health policy. In this article about research on women who are pregnant or mothering and who use alcohol, tobacco and other drugs, the “mice” include community service providers, advocates in government, women who use substances and researchers at the British Columbia Centre of Excellence for Women’s Health (BCCEWH). The “roar” comes not from a single lion, but from these multiple stakeholders using feminist organizing tactics and community-based action research methods to influence health policy. Over the past five years, researchers at the BCCEWH have worked on four such research projects to affect policy related to women who are pregnant or mothering and who use alcohol, tobacco and other drugs. The first project was catalyzed by the legal actions of Winnipeg Child and Family Services to try to force “Ms. G.,” an Aboriginal woman who was using solvents during pregnancy, into treatment. As the case moved through the Supreme Court, we started a process of building consensus among those working in the fields of substance misuse, fetal alcohol syndrome prevention and women’s health. Our goals were to open up the dialogue and move from narrow, punitive and “competing rights” approaches to the issue, and to use the input of the disparate stakeholders to guide the research direction. With seed grant monies from the BCCEWH, we researched the legal actions being taken against women who use substances during pregnancy. We also reviewed the literature on the impact of involuntary treatment, barriers to treatment experienced by pregnant and parenting women and effective alternative approaches. We created a media package of this material and held a media conference to coincide with the Supreme Court decision. Women from the BC consensus-building process who worked in government followed up on the media conference. They circulated hundreds of the media kits to provincial governmental policy makers to inform and invite discussion among regional health authorities on how health and social services systems might support rather than punish women in Ms. G.’s situation. These tactics enabled us to successfully create a context that deterred punitive legislative action against mothers in this province. We helped reframe the public debate surrounding the Supreme Court case and introduce all the stakeholders to the merits of non-coercive, caring support of women during pregnancy to prevent alcohol and other drug-related developmental disabilities. The Ms. G. case also prompted us to question what barriers pregnant and parenting women face when accessing treatment. Again, we involved those in a position to benefit from and advocate for policy change in the research process. Community alcohol and drug service providers from Prince George and Vancouver helped develop the research questions, conduct the research and disseminate the findings. The report on the findings, Apprehensions: Barriers to Treatment for Substance Using Mothers, underlines a key barrier to treatment—that women are afraid their children will be apprehended if they admit to having problems with substance use. Grounded in the pressing policy issues facing substance-using mothers and service providers in communities, this research is being used to guide decision making in a variety of contexts. For example, the Canada Drug Strategy Unit of Health Canada used our report as a basis for discussions held in March 2001 with perinatal and addictions service providers that are involved in training child welfare and other professionals who are in a position to support women’s access to care. The findings of this research were also brought to the recent provincial addictions policy development Task Group. As a result, the report of this group, Weaving Threads Together: A New Approach to Address Addictions in BC (March 2001), recommends specialized strategies to ensure women can access the services they need. Aboriginal women’s health advocates in BC have also affirmed and augmented our findings by articulating how First Nations and Metis women experience these barriers and supports to treatment. The Spring 2001 newsletter of the Women’s Health Bureau of the BC Ministry of Health is devoted to a discussion of ways to improve access to and quality of treatment for Aboriginal women.¹ In a third research project, BCCEWH researchers worked with the Sheway Project to evaluate their innovative, harm reduction approach to improving access to care for substanceusing mothers. Sheway is a program in the downtown eastside of Vancouver that offers supports and care to pregnant women and mothers who are substance users. Our research showed that when care for pregnant women focuses on the broader determinants of women’s health, such as nutrition, housing, income support, and reduction of violence, rather than more narrowly on women’s substance use, positive outcomes for the women’s health and for the prevention of fetal alcohol syndrome in their children can be achieved. Several developments indicate that the research with Sheway is having a policy impact. The BC Children’s Commission incorporated our findings into its recommendations to the BC government on the prevention of fetal alcohol syndrome. The Sheway Project’s social determinants of health, harmreduction approach is being advocated as a ‘best practice’ to programs funded nationally under Health Canada’s Prenatal Nutrition Program. The report is also being promoted by the Canadian Centre on Substance Use through their Clearinghouse on fetal alcohol syndrome. Many copies of the research report have been ordered by policy makers from several other provinces working on strategies to improve service provision to high risk, pregnant, substance using women. In order to meet the needs of community-based program providers and others, the BCCEWH wanted to make access to the findings affordable and user-friendly. A short 4-page version of the findings was published in print and web versions www.bccewh.bc.ca. Four print runs of this short report have now been done, due to high demand for use as handouts in meetings, training sessions and conferences. In 2000, a multidisciplinary team of researchers at the Centre was funded by Status of Women Canada to undertake an analysis of policy discourses on mothering under duress in three situations: mothers who are coping with an abusive intimate relationship, or with alcohol and/or other substance use, or with mental illness. Preliminary findings indicate that both official policy makers and the media judge women who are substance users more harshly than they do women who are in abusive personal relationships or who have mental health problems. This appears to be because women who use substances while pregnant or when they have a child are regarded as having chosen to use these substances, whereas women who are abused by their partners or who have mental illnesses are not held responsible for their situation. This study confirms the challenges facing women’s health advocates who support a harm reduction approach to policy and practices for women who are substance users. Developing ways to counter the dominant policy and media portrayals of women who use substances is a formidable challenge, but one that our series of projects on the barriers to treatment and successful approaches equips us to tackle. In 2001, influencing policy is still by no means an easy task for women’s health researchers. But feminist activist principles continue to offer us effective strategies for inclusive research practices, public advocacy and policy change. Mice or lion? We’ll stick with the mice that roar. NOTES British Columbia Centre of
Excellence for Women’s Health |
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